“If a patient tells the psychiatrist of the imminent arrival of the Messiah, how is the psychiatrist to distinguish between a fervent believer and a deluded psychotic?”
That is just one of the fascinating questions posed in “Sanity & Sanctity” by David Greenberg and Eliezer Witztum. The question is not just theoretical. The authors are Western-trained veteran psychiatrists at the mental health center associated with Herzog Memorial Hospital (formerly Ezrat Nashim) in Jerusalem. The center serves north Jerusalem, an area that is at least 50 percent haredi, or fervently religious.
Within the theoretical framework of cultural psychiatry, Greenberg and Witztum question how outsiders to the haredi world may competently understand, diagnose and treat unusual behaviors and symptoms. “Mental health experts and the ultra-Orthodox world are not naturally compatible,” they write, “even though both are ultimately concerned with healing the soul.”
The book discusses specific psychiatric complaints and treatments arising from the haredi community’s beliefs and lifestyle. Greenberg and Witztum take us on a meandering journey that interweaves talmudic and anthropological sources, and offers a vividly drawn sociological description of haredi life, replete with Chassidic parables and psychiatric case-histories.
Following an introduction to the haredi world and to community health work in Jerusalem, they attempt to define what distinguishes beliefs from delusions, visions from hallucinations and rituals from compulsions, quoting opinions as diverse as Maimonides, Sigmund Freud and Mary Douglas.
A biblical example: What makes Moses, who saw and heard God at the burning bush, a visionary rather than a hallucinating … psychotic, conclude Greenberg and Witztum, is that he shows “awareness of his own experiences.”
In a contemporary example of hallucinations, they describe a recurrent clinical picture in male haredi teenagers, comprising extreme withdrawal, paranoid tendencies and nocturnal hallucinations of frightening or demonic figures. The authors believe the latter symptom to be specific to this population and influenced by Jewish textual references to the dangers of night.
Greenberg and Witztum speculate that these boys suffered from learning disabilities and were unable to fulfill their expected role as Talmud students, leading to feelings of deep shame, interpersonal problems and low self-esteem. The analysis is credible. However, their contention that “special education facilities are rare and unpopular among this population” is only partially true today. At least 10 institutions now exist in Jerusalem catering to haredi boys with learning difficulties.
The role of ritual in haredi life is addressed in three chapters. Firstly, there are “normative rituals,” which may appear abnormal to an outsider. For example, a haredi adolescent praying at “60 shakes a minute” may be releasing pent-up energy that has secular counterpart achieves through a 160 kilometer-per-hour ride on a motorbike.
Secondly, there are rituals familiar to psychiatrists as part of obsessive-compulsive disorder. Greenberg and Witztum identify four areas that dominate the clinical presentation of religious symptoms in obsessive-compulsive disorder among haredi patients: devotion in prayer, meticulous observance of the dietary laws, the family purity laws and the laws of cleanliness before prayer.
They reject the claim that ritualized haredi life actually induces the disorder, and conclude that it is the setting rather than the catalyst.
The question of psychopathology among the newly fervently religious is the topic of the book’s third section. While no epidemiological studies have been done, referral rates to the authors’ clinic indicate higher-than-expected levels of pathology among this group.
The authors also found that newly fervently religious in their clinic were particularly attracted to Bratislav Chassidism — which aspires to spirituality through song, dance, communion with nature and prayer at the graves of righteous men.
One chapter is devoted to the phenomenon of the so-called “Jerusalem syndrome” — which is not actually specific to Jerusalem, as similar cases have been identified in other cities of religious significance. The term refers to tourists who develop psychotic symptoms involving religious or mystical themes. Sadly, they often end their “holiday” to Jerusalem in one of its psychiatric hospitals.
Writing lucidly with humor and humility, the authors maintain a questioning, non-dogmatic tone throughout their expansive and in-depth discussions of the topics covered. Clear, yet learned descriptions on the intricacies of haredi life make the book accessible to those with no previous knowledge, and a glossary and interesting notes make reading this thoughtful book an enjoyable and enriching experience.
“Sanity and Sanctity: Mental Health Work Among the Ultra-Orthodox in Jerusalem” by David Greenberg and Eliezer Witztum (332 pages, Yale University Press, $40).